Abstract
In this study, we aimed to investigate the effectiveness of debridement, antibiotics, irrigation, and implant retention (DAIR) in periprosthetic hip joint infection caused by multidrug-resistant (MDR) Acinetobacter baumannii (A. baumannii).From July 2019 to June 2020, we retrospectively reviewed all patients treated for periprosthetic hip joint infections caused by MDR A. baumannii at our institution. The diagnosis of periprosthetic joint infection (PJI) was established based on the Musculoskeletal Infection Society (MSIS) 2018 criteria. The Charlson Comorbidity Index (CCI) was used to estimate the risk of mortality. The patients were followed up for over a year, until their death, or loss to follow-up.Four patients (three females and one male), with a mean age of 68 years, were included in the study. A. baumannii exhibited resistance to fluoroquinolones in all cases. All patients were treated with the DAIR procedure followed by intravenous tigecycline and colistin combination treatment. Prosthesis retention with good functional results was achieved in two patients. One patient required resection arthroplasty and one patient died two months after the initial surgical treatment, yielding a success rate of 50% for the DAIR procedure.Periprosthetic hip joint infection caused by MDR A. baumannii is one of the most demanding and challenging complications in orthopaedic practice. This case series suggests that the outcome of the DAIR is affected by a number of factors that are in a complex interplay. Our results indicate a limited success rate for the DAIR procedure in the treatment of a periprosthetic hip joint infection caused by MDR A. baumannii.
Highlights
Periprosthetic joint infection (PJI) is a rare but major complication after hip replacement, with an incidence of 0.5-3%; it results in significant morbidity and mortality [1]
Our results indicate a limited success rate for the DAIR procedure in the treatment of a periprosthetic hip joint infection caused by MDR A. baumannii
This study presented a case series of periprosthetic joint infection (PJI) due to MDR A. baumannii managed with the DAIR procedure
Summary
Periprosthetic joint infection (PJI) is a rare but major complication after hip replacement, with an incidence of 0.5-3%; it results in significant morbidity and mortality [1]. The risk of developing a PJI is associated with several potentially patient-related factors, such as sociodemographic characteristics, body mass index (BMI), and medical/surgical history [2]. Management of a PJI is challenging and usually requires complex treatment strategies in order to provide favorable outcomes related to patients’ quality of life [3]. For early postoperative PJIs (occurring within 30 days of implantation), debridement, antibiotics, irrigation, and implant retention (DAIR) is the conventional treatment option. The DAIR procedure should be performed promptly after the onset of the symptoms of infection [2]. Failure of the DAIR is related to existing preoperative parameters, such as the immunocompromised state in patients, persistent wound drainage, and specific bacterial pathogens isolated from the culture [4]
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